Summary
Overview
Work History
Education
Skills
Timeline
Generic

Megan Hoffeditz

Kankakee,IL

Summary

  • 9 years Insurance Experience
  • Over 10 years experience in Customer Service
  • Organized and detail-oriented
  • Medicare Part D & Supplemental Insurance Knowledge
  • ICD-10 and Medical Claim Knowledge
  • Quick learner. Authorized to work in the US for any employer

Claims professional with robust background in resolving high-stakes claims and ensuring compliance with regulatory standards. Known for fostering team collaboration and driving results, adaptable to changing circumstances while maintaining focus on key priorities. Excels in risk assessment, customer relations, and problem-solving.

Overview

15
15
years of professional experience

Work History

Senior Claims Representative

Cigna
03.2023 - Current
  • Processed and resolved insurance claims in a timely and accurate manner, ensuring customer satisfaction
  • Reviewed policy coverage to determine claim eligibility and validity
  • Investigated and evaluated claims by gathering relevant information from various sources and medical records
  • Maintained detailed records of all interactions, correspondence, and transactions related to each claim
  • Verified accuracy of submitted documents such as police reports, medical bills, itemized statements, etc.
  • Managed a caseload of 100+ active insurance claims simultaneously while meeting strict deadlines

Pharmacy Prior Authorization Senior Representative

Cigna
08.2016 - 03.2023
  • Addressed internal inquiries through Management Email Box.
  • Resolved technical inquiries with precision and efficiency.
  • Contribute to resolving tasks in the specialist workbasket.
  • Coordinated prior authorization tasks for Medicare prescriptions.
  • Handled supervisor-level customer calls to resolve issues efficiently.
  • Contributed to multiple company initiatives when necessary.
  • Reviewed and processed prior authorization requests for medical procedures, medications, and durable medical equipment
  • Collaborated with healthcare providers to gather necessary clinical documentation for prior authorization submissions
  • Maintained accurate records of all prior authorization activities in electronic health record systems
  • Adhered to HIPAA regulations and maintained strict confidentiality when handling sensitive patient information during the prior authorization process
  • Maintained a high level of professionalism and customer service when interacting with patients and providers

Office Coordinator

Heatwave Home Services
02.2016 - 08.2016
  • Operated advanced telephone system for seamless communication.
  • Coordinated appointment scheduling and rescheduling.
  • Ensured accurate billing for all service tickets.
  • Executed payroll tasks and maintained organized time sheet documentation.
  • Recorded payments for services rendered and tenant rent.
  • Oversaw significant cash handling operations each day.
  • Prepared necessary paperwork for job permits.
  • Proficient using over 4 different computer systems on a daily basis.
  • Managed and executed debt recovery processes.
  • Streamlined filing processes for improved accessibility.

Customer Service Representative

Hinrich Inc, 1940
03.2014 - 11.2014
  • Managed incoming calls related to billing and business matters.
  • Initiated calls to potential clients to offer company services.
  • Scheduled client meetings to discuss service agreements.
  • Generated and dispatched service invoices for technicians.
  • Handled customer communications each day.
  • Resolved customer concerns through effective solutions.
  • Delivered precise and prompt information to incoming customers.
  • Processed cash, check, and credit payments.
  • Managed and directed incoming phone calls to appropriate departments.

CLS Operations

Baker And Taylor Books
10.2013 - 02.2014
  • Ensured readiness of products for dispatch.
  • Oversaw multiple functions within the production cycle.
  • Tailored library shipments to align with coordinators' specifications.

Customer Service and Sales Representative

Best Buy
10.2012 - 10.2013
  • Handled transactions with accuracy and speed.
  • Balanced cash drawers and managed deposits efficiently.
  • Remain knowledgeable about current sales and security measures.
  • Coordinated special orders to fulfill customer requests.
  • Answered and transferred incoming calls.
  • Facilitated merchandise exchanges for customers.
  • Supervised logistics for order fulfillment.
  • Organized retrieval of items needing repair.
  • Scheduled appointments for in-home installations.

Lifeguard

Splash Valley
05.2010 - 08.2010
  • Achieved CPR certification.
  • Contributed to swim lesson preparation during early hours.
  • Provided immediate medical assistance to injured individuals through first aid and CPR.
  • Executed rescue operations for distressed individuals utilizing specialized techniques and equipment.

Education

High School Diploma -

HERSCHER HIGH SCHOOL
Herscher, IL
06.2012

Skills

  • ICD-10
  • Coverage verification
  • Liability assessment
  • Claims processing
  • Claims investigation
  • Claims analysis
  • Multitasking Abilities
  • Analytical problem solving
  • Customer engagement
  • Complaint handling

Timeline

Senior Claims Representative

Cigna
03.2023 - Current

Pharmacy Prior Authorization Senior Representative

Cigna
08.2016 - 03.2023

Office Coordinator

Heatwave Home Services
02.2016 - 08.2016

Customer Service Representative

Hinrich Inc, 1940
03.2014 - 11.2014

CLS Operations

Baker And Taylor Books
10.2013 - 02.2014

Customer Service and Sales Representative

Best Buy
10.2012 - 10.2013

Lifeguard

Splash Valley
05.2010 - 08.2010

High School Diploma -

HERSCHER HIGH SCHOOL

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